What is this premature performance costing the taxpayer?

There is something decidedly unwise about pushing ahead with the Medicare Rebate changes supposedly still scheduled to start on Monday, January 19th when those changes are still subject to a Senate vote.

As several news outlets reported today, including The Sydney Morning Herald and the ABC News, when the Senate resumes in February it is most likely the changes will be disallowed.

Donating Blood

What changes have already been made to the Medicare computer systems to implement the change? We, the taxpayer have paid for those. How much did that cost? If the Senate disallows the changes, how much will the taxpayer have to pay to roll back the changes?

Then there is the question of the reduced rebates paid in the meantime. Most patients will have paid up front. Some patients will have been bulk-billed and any roll-back will require payments to either the medical provider or the patient. Or is it that the period from January 19 to the date the Senate disallows the changes will just be a period of disallowed reduced rebates? Does that mean people should wait until March to go to the doctor?

I am not against well planned and justified changes to Medicare. The Superannuation Guarantee Levy was a MAJOR change for Australia, but there were transition provisions enabling adequate planning for the future. Structural changes to a system as important as Medicare need very careful analysis and planning, taking into account all considerations.

There is also the question of who is penalised for what. If the government suspects certain doctors of over-billing, deal with that issue, don’t penalise the people needing health care! Address the root cause, do not penalise the innocent.

A friend of mine and I strongly disagree on the topic of Medicare changes. He says too many people go to the doctor and waste the doctors’ time and a price point may prevent that. My friend may have a point: we have perhaps lost the ability to take care of relatively minor ailments ourselves. We perhaps don’t drink enough water, we eat bad foods and we get a stomach ache: the doctor tells us to go home and drink more water. Did we really need a medical consultation? No, we needed to be more aware of our own bodies.

Short consultations seem to be the government’s biggest concern. Let’s consider the costs around a consultation of any length. There is the patient change over time at the start and end of the consultation, the recording of the consultation details, any stationery costs, processing the payment and/or Medicare claim. Those costs are direct costs for each and every consultation irrespective of the direct labour cost of the doctor.

One impost on the health system is the requirement for medical certificates for work when sick. Now, as a manager, yes, I like to have a certificate to confirm an employee was unwell. However, as a doctor in Canada has pointed out, this is a waste of the time and resources of the health system. Even if this letter isn’t genuine, the concerns are valid.

As a business operator in Nova Scotia, I am asking for your support in helping to alleviate an unnecessary pressure on the health-care system. I am hoping you will consider revisiting your current absenteeism policy and remove the requirement for your employees to obtain a medical note for missed time from work.

This policy creates an unnecessary burden on the health-care system and also exposes seriously ill patients in my office to viruses that could cause detrimental consequences to their health. In most cases, the best remedy for a patient with an isolated illness (i.e., gastrointestinal virus or common cold) is to stay home, rest and drink fluids. Coming to a doctor’s office or an emergency room for a medical note does not complement their recovery.

If, for whatever reason, your business decides to continue to require a physician to authorize their employee’s absenteeism, I will require your employee to bring with them a written request from the organization for the medical note. Upon providing this service I will invoice your company $30.00 per medical note. This is standard practice when providing non-medical necessary services for third-party organizations.

These are normally short consultations. Clearly we have two parties with conflicting needs here and the patient/employee stuck in the middle. If you have influenza, do you REALLY feel like dragging yourself to the doctor to prove it? No. Does the doctor really need to see you? No. Is the employer justified in requiring proof you were sick? Yes. How do we solve this problem?

My friend worries that some doctors own four houses and many of us are lucky to own one. I’m not sure that is justification for messing with Medicare, which is the peoples’ insurance, not the doctors’ insurance. Many of our politicians own more than one house too: should we scrap the House of Representatives?

I have digressed, as is often my wont. I’d really like to know how much this exercise, implemented in great haste and which looks likely to be thrown out, has cost the taxpayer. How much will it cost to roll back?

The RACGP petition is still open. Sign it! Edit Jan 16: Petition is now closed, but you can read the comments and updates. We won a reprieve!

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10 comments on “What is this premature performance costing the taxpayer?”

Doctors certificates for illness are really a waste of time anyway. If someone goes in and asks for one for X illness, is the doctor going to say no? Not likely, so why not take away the need for them for anyone who’s off work for less than 5 days?

I have a chronic condition (Crohn’s). I’ll be on medication for the rest of my life and also have to manage my diet in order to keep it under control. My specialist prescribes my medication and monitors me. He will decide if/when I need to make a change. So why do I need to see my GP every few months in order to get a repeat prescription? And how many others in his waiting room are there for the very same reason – not because they are ill or are worried about certain symptoms, but because they need a piece of paper so they can continue on their medication?

There are many ways the government could cut down on pointless GP visits. Making people pay isn’t the answer. Very relieved to see that these changes have been shelved for the time being. Let’s hope it’s permanent!

As a nurse in Victoria’s public health system for over 25 years, I know better than most the absolutely vital, cost effective, preventative and interventionist role Australia’s General Practitioners play in keeping our public health system lean, responsive and affordable.

Despite a near doubling in population, and a significant increase in the incidence of chronic diseases, Medicare still accounts for less than 10% of GDP, almost half of America’s far less equitable health care costs. And while there are areas of our public health care that could be improved, targeting GPs is short-sighted and displays a lack of knowledge about how other health care system works, or betrays that this is an ideological, not economic decision – perhaps both.

It’s not just the immediate impact on already-stretched emergency departments that’s the problem – patients will avoid seeking health care until treatable conditions reach crisis point, and fail to seek early intervention for worsening chronic conditions, which is far more expensive in the long term, for individuals, families and communities, even accounting for self-limiting conditions that didn’t need medical attention.

Three common examples from my clinical practice:
– instead of a course of oral antibiotics and a quick return to work, school or normal domestic work, delaying intervention for what seems like a cold but is really pneumonia becomes several days in hospital, on intravenous antibiotics, with x-rays, oxygen therapy, regular blood work, and a recuperation time of weeks – and that’s an uncomplicated case.
– an infected leg ulcer in someone with delayed wound healing, from circulatory disease, diabetes, cancer among other conditions, is already prone to taking months to heal; without rapid intervention and regular assessment and dressings, that time can stretch to years, involving hospital admissions and surgical grafting.

Tens of thousands of dollars, instead of a rebate that allows doctors to make a living in a specialty that is too little regarded by those who fail to appreciate that a good GP is worth her weight in platinum, saving lives and saving the system money.

Oh, and I very much doubt there are many bulk-billing GP’s with four houses – certainly far fewer, both as a percentage and (perhaps) outright, as there are business people who rely in part or in whole on government payments – like Ahmed Fahour, the CEO of AusPost, whose annual salary is $4.8 million….

You and I have similar concerns. Your paragraph explains it so clearly.

It’s not just the immediate impact on already-stretched emergency departments that’s the problem – patients will avoid seeking health care until treatable conditions reach crisis point, and fail to seek early intervention for worsening chronic conditions, which is far more expensive in the long term, for individuals, families and communities, even accounting for self-limiting conditions that didn’t need medical attention.

Your examples are excellent.

We are in for a ride!

I’ve offered to be on the consultation panel or review panel or whatever they want to call it.

Here here Robyn. I refuse to believe this is anything other than punishment for the failure of the $7 copayment. Interestingly as a CEO with a considerable sized workforce in the human services industry, which is notorious for it’s casualisation and low levels of pay, introduced a policy whereby a doctor’s certificate only had to be produced for “sick leave” that extended beyond three days or where a person took more than ten extra sick days in a calendar year over and above their entitlement. Staff could also negotiate “mental health leave” in the form of extra paid days to take time off work when they were stressed, close to burning out or under duress due to circumstances at work, for example the death of a client that they worked very closely with. The result of the policy? A marked reduction in the number of sick days taken across all staff, a marked reduction in WorkCover claims for psychological injury, a marked reduction in “presenteeism” and a significant savings in the wages on-costs. It’s just good business.

I don’t believe that reactionary policy like this will do anything to address the cost of the Medicare. We need to find a recurrent source of income that is dedicated to a system that is the envy of civilised countries around the globe. Without Medicare we face the prospect of only providing health services to the “worried well” who can afford treatment while those with treatable disease and illness will suffer – we could erode our workforce and our tax paying population simply because people would not be able to afford the medical treatment necessary to stop a short term disease process from becoming an incapacitating lifelong burden. Our country is rich in resources. Resources that should belong to all of us. Why are we not sharing the wealth of those resources by keeping medical treatment accessible for all Australians? I understand that the resources are not a endless source of income but taxed appropriately the revenue would go a long way towards preserving a fair and accessible system for all.

I’m definitely with you on this one Robyn.
I am a ‘heart patient’ after having a stent inserted a couple of years ago. I have certain medications that need a Drs. appt. so that I can get that script. It is one of those under 10 min. visits. I also need to make sure that my blood pressure is taken on a relatively regular basis, this also falls under the 10 minutes.
The people who are making the decisions about our Medicare do not or have not given any thought to those of us who are getting on in years & need to make sure that we keep ourselves as healthy as we can.
The Abbott led LNP have shown yet again that they lack credibility when it comes to caring for the general public.

The other consideration is how often do expected short consultations turn into long consultations? Doctors have to be able to be flexible. One of my consultations was way longer than expected, while the next one was quite short.

“I’m no better.”

“Time for an ultrasound, then.”

But the
two consultations would have balanced out.

What happens if on one of your short, get my blood pressure checked only visits, your blood pressure leads to a longer consultation? I’m not sure we can turn the medical profession into the accounting profession and bill everything in six minute blocks, frankly.

While I agree overall with your thoughts, on the first issue about implementing these changes at a cost which might turn out to be wasted…

I’ve worked in Government for 30 years and this is standard practice for changes introduced by regulation. When the Government tables a regulation, it becomes effective immediately even during the period of disallowance. Many regulations are tabled and never disallowed, which allows the standard processes of Government to continue.

It’s only with primary legislation where changes aren’t implemented until passed by the Parliament.

However, I think it is poor management to table a regulation and commence implementation if you’re unsure whether you have the numbers to defeat any disallowance motion. It’s daring the other side to step down, rather than negotiating the content of the regulation before tabling it so that you know it won’t be disallowed.

I think this is why the ALP was so successful in getting legislation passed, despite the cries of “crisis” and “chaos”. They genuinely negotiated with minor parties so that they knew that any legislation or regulation would be passed when the time came.

I can understand regulation changes being implemented where there is little chance of the changes being disallowed. However in this particular case none of the proposals to date have received support from either the electorate, the opposition or the profession. One would think common sense might prevail!

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